‘Too much variation’ in community pharmacy services

There is ‘too much variation’ in awareness and provision of community services across the country, an annual conference hosted by the King’s Fund this week has heard.

The panel included Community Pharmacy England director of NHS services Alastair Buxton, who suggested that there needed to be a ‘stronger baseline’ of services provided by every single community pharmacy, as well as diverse commissioning to meet local needs.

The panel also highlighted the need for other healthcare professionals and the public to be aware of what community pharmacies can do and use and refer to services appropriately.

Patricia Wright, a pharmacist and chief executive of the Hillingdon Hospitals NHS Trust, praised the accessibility of community pharmacy services.

But she added: ‘We haven’t got it right in terms of thinking about how that community resource is used.’

She suggested there was ‘too much variation’ in public awareness of what community pharmacies could offer, as it was not ‘front and foremost’ in public healthcare messaging.

However, she also said that ‘even if it was front and foremost, the service is too patchy at the moment’, adding that issues with variability of service quality also affected other primary care providers, such as general practice and optometry.

Acute trusts could also be making more and better use of community pharmacies and refer patients to them where appropriate, added Ms Wright.

Mr Buxton told delegates that he agreed with Ms Wright about the consistency of community pharmacy services.

He said one of the criticisms that CPE had received about their recently published vision developed with the Nuffield Trust and the King’s Fund was that it was not ambitious enough, with some pharmacists saying they already did what it described.

‘I’d say, “well, do you really? And actually, even if you do, perhaps you're this wonderful, standout pharmacy, actually, not all pharmacies do”,’ Mr Buxton said.

‘And even with all of the national commissioning from NHS England, we don't have that consistency of offer for patients.’

‘We need a stronger baseline of services that every single pharmacy is providing, so that every patient can know every pharmacy is providing it. And then we can address that in terms of behaviour change of the public and patients through advertising and the like,’ he added.

In addition, there needed to be ‘diversity of commissioning at a local level to meet the needs of individual population groups’, particularly with regard to public health services, Mr Buxton suggested.

However, he said the negotiator was in a ‘difficult position in terms of selling this vision for the future’.

‘We genuinely believe there's so much more that community pharmacy could do for patients and working with our primary care and wider NHS colleagues,’ he said.

But to do so, he said the sector needed action on workforce and financial investment, including investment in premises.

And he suggested that in order to create adequate premises to provide clinical services, ‘some pharmacies may end up merging together to achieve that critical mass’.

‘But as always, everything tends to come down to money in the NHS as a kind of key enabler,’ Mr Buxton added.

The ‘hardest issue to address’, he said, would be to build trust in the community pharmacy sector among other healthcare professionals, and to build relationships between local primary care providers.

Another member of the panel, East London GP Dr Farzana Hussain, shared a positive experience of working with community pharmacy colleagues.

She said that ‘very quickly’ after beginning to refer patients to the Community Pharmacy Consultation Scheme (CPCS), community pharmacy teams were able to see around 15 patients – or ‘one clinic’s worth’ – of patients who would otherwise have seen a GP each week.

To reassure patients, the practice said if the patient needed to be referred back to the GP, they would see them that same day, and kept an appointment slot free for that purpose.

‘That appointment… it’s probably used once a month,’ Dr Hussain told delegates.

‘For me, as a GP partner, as an employer, as a business owner, [CPCS has] been fabulous,’ she added.

With GPs struggling to meet patient demand, she said ‘a big thank you to our pharmacists for helping us, because our patients need it’.

And she emphasised the value of strong personal relationships between local healthcare providers.